Healthcare Provider Details

I. General information

NPI: 1780232769
Provider Name (Legal Business Name): RACHEL CRAMER LAT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2019
Last Update Date: 09/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9220 BASS LAKE RD STE 350
NEW HOPE MN
55428-3095
US

IV. Provider business mailing address

4205 CHESTNUT LN NE
PRIOR LAKE MN
55372-1184
US

V. Phone/Fax

Practice location:
  • Phone: 763-208-9545
  • Fax:
Mailing address:
  • Phone: 612-269-9716
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number3290
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: